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Robert James Cusimano
Kassem A. Ashe
James G. Abel
Samuel V. Lichtenstein
Tomas A. Salerno
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Ann Thorac Surg 1991;52:934-938
© 1991 The Society of Thoracic Surgeons

Articles

Myocardial protection in the hypertrophied right ventricle

Robert James Cusimano, MD, Kassem A. Ashe, MD, Ian D. Chin, BSc, Peter Chi, BSc, James G. Abel, MD, Samuel V. Lichtenstein, MD, PhD, Tomas A. Salerno, MD*

Division of Cardiovascular Surgery, St. Michael's Hospital, the Institute of Medical Science and the University of Toronto, Toronto, Ontario, Canada

* Address reprint requests to Dr Salerno, Division of Cardiovascular Surgery, St Michael's Hospital, 30 Bond St, Toronto, Ont, Canada M5B 1W8.

Hypertrophied right ventricle presents a sensitive state that may not be adequately protected by modern cardioplegic methods. Cardiac metabolism, performance, and ultrastructure were measured in response to 1 hour of cardioplegic arrest in 15 pigs with right ventricular hypertrophy using intermittent hypothermic crystalloid, blood, and Fluosol DA 20%-based cardioplegia. Reperfusion time was 1 hour. One hour after a 60-minute cross-clamp period, there were no differences in light microscopy. Total energy stores increased in 4 of 5 animals given blood cardioplegia compared with 1 of 5 for each of the other groups. Cardiac performance data also showed better results for animals treated with blood cardioplegia. After 30 minutes of reperfusion, animals receiving blood cardioplegia recovered 131% ± 42% of preoperative systolic performance compared with 106% ± 49% for Fluosol-treated animals and only 82% ± 27% recovery for the crystalloid-treated group. After 60 minutes of reperfusion, the blood group showed 119% ± 20% recovery compared with 89% ± 23% and 85% ± 50% recovery for Fluosol- and crystalloid-treated hearts, respectively. In conclusion, blood cardioplegia provided better protection than did crystalloid or Fluosol DA 20% cardioplegia when animals with right ventricular hypertrophy underwent 1 hour of cardioplegic arrest. It may have repaired damaged myocardium, leaving better hearts after cross-clamping than before.




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